Admission cortisol and adrenocorticotrophic hormone levels in children with meningococcal disease: Evidence of adrenal insufficiency?
OBJECTIVE:To measure admission cortisol and adrenocorticotrophic hormone (ACTH) levels in children with meningococcal disease to try and determine the prevalence of adrenal insufficiency. DESIGN:Prospective observational study. SETTING:Pediatric departments of four hospitals in Merseyside, United Ki...
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| Veröffentlicht in: | Critical care medicine 1999-10, Vol.27 (10), p.2257-2261 |
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| creator | Riordan, F Andrew I Thomson, Alistair P. J Ratcliffe, Jane M Sills, John A Diver, Michael J Hart, C Anthony |
| description | OBJECTIVE:To measure admission cortisol and adrenocorticotrophic hormone (ACTH) levels in children with meningococcal disease to try and determine the prevalence of adrenal insufficiency.
DESIGN:Prospective observational study.
SETTING:Pediatric departments of four hospitals in Merseyside, United Kingdom.
PATIENTS:Ninety-six children with meningococcal disease; 29 with hypotension, ten of whom died.
MEASUREMENTS AND MAIN RESULTS:Admission cortisol, ACTH, and proinflammatory cytokine levels were measured. Serial cortisol levels also were measured during the first 48 hrs.Significantly lower cortisol levels were found in those who died compared with survivors. Significantly higher ACTH levels also were found in those who died. However, no child had a cortisol level |
| doi_str_mv | 10.1097/00003246-199910000-00032 |
| format | Article |
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DESIGN:Prospective observational study.
SETTING:Pediatric departments of four hospitals in Merseyside, United Kingdom.
PATIENTS:Ninety-six children with meningococcal disease; 29 with hypotension, ten of whom died.
MEASUREMENTS AND MAIN RESULTS:Admission cortisol, ACTH, and proinflammatory cytokine levels were measured. Serial cortisol levels also were measured during the first 48 hrs.Significantly lower cortisol levels were found in those who died compared with survivors. Significantly higher ACTH levels also were found in those who died. However, no child had a cortisol level <5 μg/dL (<138 nmol/L) implying definite adrenal insufficiency. Three of 29 children with hypotension had plasma cortisol levels implying possible adrenal insufficiency (<18 μg/dL [<497 nmol/L]), but high ACTH levels were only found in one of those three.Cortisol levels decreased significantly after antibiotic treatment, unless steroid therapy was administered. ACTH levels did not correlate with cortisol or proinflammatory cytokine levels.
CONCLUSIONS:Children with meningococcal disease have a wide range of initial plasma cortisol levels, with lower levels found in those who die. Many factors may affect cortisol levels, but adrenal insufficiency is probably uncommon.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/00003246-199910000-00032</identifier><identifier>PMID: 10548217</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins, Inc</publisher><subject>Adolescent ; Adrenal Insufficiency - blood ; Adrenal Insufficiency - diagnosis ; Adrenal Insufficiency - etiology ; Adrenal Insufficiency - prevention & control ; Adrenals. Adrenal axis. Renin-angiotensin system (diseases) ; Adrenocorticotropic Hormone - blood ; Adrenocorticotropic Hormone - deficiency ; Bacterial diseases ; Biological and medical sciences ; Biomarkers - blood ; Child ; Child, Preschool ; Dexamethasone - therapeutic use ; Diagnosis, Differential ; Diagnostic Tests, Routine ; Endocrinopathies ; Glucocorticoids - therapeutic use ; Human bacterial diseases ; Humans ; Hydrocortisone - blood ; Hydrocortisone - deficiency ; Infant ; Infectious diseases ; Medical sciences ; Meningococcal Infections - blood ; Meningococcal Infections - complications ; Miscellaneous ; Non tumoral diseases. Target tissue resistance. Benign neoplasms ; Patient Admission ; Prospective Studies</subject><ispartof>Critical care medicine, 1999-10, Vol.27 (10), p.2257-2261</ispartof><rights>1999 Lippincott Williams & Wilkins, Inc.</rights><rights>1999 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3852-ccaf47478c4694c945a83f4d8295e94a977130ee731ed65081f588fa5ebf21e83</citedby><cites>FETCH-LOGICAL-c3852-ccaf47478c4694c945a83f4d8295e94a977130ee731ed65081f588fa5ebf21e83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1999261$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10548217$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Riordan, F Andrew I</creatorcontrib><creatorcontrib>Thomson, Alistair P. J</creatorcontrib><creatorcontrib>Ratcliffe, Jane M</creatorcontrib><creatorcontrib>Sills, John A</creatorcontrib><creatorcontrib>Diver, Michael J</creatorcontrib><creatorcontrib>Hart, C Anthony</creatorcontrib><title>Admission cortisol and adrenocorticotrophic hormone levels in children with meningococcal disease: Evidence of adrenal insufficiency?</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVE:To measure admission cortisol and adrenocorticotrophic hormone (ACTH) levels in children with meningococcal disease to try and determine the prevalence of adrenal insufficiency.
DESIGN:Prospective observational study.
SETTING:Pediatric departments of four hospitals in Merseyside, United Kingdom.
PATIENTS:Ninety-six children with meningococcal disease; 29 with hypotension, ten of whom died.
MEASUREMENTS AND MAIN RESULTS:Admission cortisol, ACTH, and proinflammatory cytokine levels were measured. Serial cortisol levels also were measured during the first 48 hrs.Significantly lower cortisol levels were found in those who died compared with survivors. Significantly higher ACTH levels also were found in those who died. However, no child had a cortisol level <5 μg/dL (<138 nmol/L) implying definite adrenal insufficiency. Three of 29 children with hypotension had plasma cortisol levels implying possible adrenal insufficiency (<18 μg/dL [<497 nmol/L]), but high ACTH levels were only found in one of those three.Cortisol levels decreased significantly after antibiotic treatment, unless steroid therapy was administered. ACTH levels did not correlate with cortisol or proinflammatory cytokine levels.
CONCLUSIONS:Children with meningococcal disease have a wide range of initial plasma cortisol levels, with lower levels found in those who die. Many factors may affect cortisol levels, but adrenal insufficiency is probably uncommon.</description><subject>Adolescent</subject><subject>Adrenal Insufficiency - blood</subject><subject>Adrenal Insufficiency - diagnosis</subject><subject>Adrenal Insufficiency - etiology</subject><subject>Adrenal Insufficiency - prevention & control</subject><subject>Adrenals. Adrenal axis. Renin-angiotensin system (diseases)</subject><subject>Adrenocorticotropic Hormone - blood</subject><subject>Adrenocorticotropic Hormone - deficiency</subject><subject>Bacterial diseases</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Dexamethasone - therapeutic use</subject><subject>Diagnosis, Differential</subject><subject>Diagnostic Tests, Routine</subject><subject>Endocrinopathies</subject><subject>Glucocorticoids - therapeutic use</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Hydrocortisone - blood</subject><subject>Hydrocortisone - deficiency</subject><subject>Infant</subject><subject>Infectious diseases</subject><subject>Medical sciences</subject><subject>Meningococcal Infections - blood</subject><subject>Meningococcal Infections - complications</subject><subject>Miscellaneous</subject><subject>Non tumoral diseases. Target tissue resistance. Benign neoplasms</subject><subject>Patient Admission</subject><subject>Prospective Studies</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1ks9u3CAQxlHVqNkkfYWKQ9WbWzBgQy9VFKVNpUi9JGdE8FDTYtiCnVUeoO9ddr39cykXNDO_7xsxA0KYkreUqP4dqYe1vGuoUoruo-aQeYY2VLAatIo9RxtCFGkYV-wUnZXyjRDKRc9eoFNKBJct7Tfo5-Uw-VJ8itimPPuSAjZxwGbIENMhZdOc03b0Fo8pTykCDvAIoWBfNaMPexLv_DziCaKPX6vKWhPw4AuYAu_x9aMfIFrAya2-tehjWZzz1tfC04cLdOJMKPDyeJ-j-4_Xd1c3ze2XT5-vLm8by6Rom2rreM97aXmnuFVcGMkcH2SrBChuVN9TRgB6RmHoBJHUCSmdEfDgWgqSnaM3q-82px8LlFnXx1sIwURIS9GdahlVraigXEGbUykZnN5mP5n8pCnR-xXo3yvQf1agD5kqfXXssTxMMPwjXGdegddHwJQ6J5dNtL785apf29GK8RXbpTBDLt_DsoOsRzBhHvX_fgD7BerXoGQ</recordid><startdate>199910</startdate><enddate>199910</enddate><creator>Riordan, F Andrew I</creator><creator>Thomson, Alistair P. J</creator><creator>Ratcliffe, Jane M</creator><creator>Sills, John A</creator><creator>Diver, Michael J</creator><creator>Hart, C Anthony</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>199910</creationdate><title>Admission cortisol and adrenocorticotrophic hormone levels in children with meningococcal disease: Evidence of adrenal insufficiency?</title><author>Riordan, F Andrew I ; Thomson, Alistair P. J ; Ratcliffe, Jane M ; Sills, John A ; Diver, Michael J ; Hart, C Anthony</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3852-ccaf47478c4694c945a83f4d8295e94a977130ee731ed65081f588fa5ebf21e83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Adolescent</topic><topic>Adrenal Insufficiency - blood</topic><topic>Adrenal Insufficiency - diagnosis</topic><topic>Adrenal Insufficiency - etiology</topic><topic>Adrenal Insufficiency - prevention & control</topic><topic>Adrenals. Adrenal axis. Renin-angiotensin system (diseases)</topic><topic>Adrenocorticotropic Hormone - blood</topic><topic>Adrenocorticotropic Hormone - deficiency</topic><topic>Bacterial diseases</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - blood</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Dexamethasone - therapeutic use</topic><topic>Diagnosis, Differential</topic><topic>Diagnostic Tests, Routine</topic><topic>Endocrinopathies</topic><topic>Glucocorticoids - therapeutic use</topic><topic>Human bacterial diseases</topic><topic>Humans</topic><topic>Hydrocortisone - blood</topic><topic>Hydrocortisone - deficiency</topic><topic>Infant</topic><topic>Infectious diseases</topic><topic>Medical sciences</topic><topic>Meningococcal Infections - blood</topic><topic>Meningococcal Infections - complications</topic><topic>Miscellaneous</topic><topic>Non tumoral diseases. Target tissue resistance. Benign neoplasms</topic><topic>Patient Admission</topic><topic>Prospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Riordan, F Andrew I</creatorcontrib><creatorcontrib>Thomson, Alistair P. J</creatorcontrib><creatorcontrib>Ratcliffe, Jane M</creatorcontrib><creatorcontrib>Sills, John A</creatorcontrib><creatorcontrib>Diver, Michael J</creatorcontrib><creatorcontrib>Hart, C Anthony</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Riordan, F Andrew I</au><au>Thomson, Alistair P. J</au><au>Ratcliffe, Jane M</au><au>Sills, John A</au><au>Diver, Michael J</au><au>Hart, C Anthony</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Admission cortisol and adrenocorticotrophic hormone levels in children with meningococcal disease: Evidence of adrenal insufficiency?</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>1999-10</date><risdate>1999</risdate><volume>27</volume><issue>10</issue><spage>2257</spage><epage>2261</epage><pages>2257-2261</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVE:To measure admission cortisol and adrenocorticotrophic hormone (ACTH) levels in children with meningococcal disease to try and determine the prevalence of adrenal insufficiency.
DESIGN:Prospective observational study.
SETTING:Pediatric departments of four hospitals in Merseyside, United Kingdom.
PATIENTS:Ninety-six children with meningococcal disease; 29 with hypotension, ten of whom died.
MEASUREMENTS AND MAIN RESULTS:Admission cortisol, ACTH, and proinflammatory cytokine levels were measured. Serial cortisol levels also were measured during the first 48 hrs.Significantly lower cortisol levels were found in those who died compared with survivors. Significantly higher ACTH levels also were found in those who died. However, no child had a cortisol level <5 μg/dL (<138 nmol/L) implying definite adrenal insufficiency. Three of 29 children with hypotension had plasma cortisol levels implying possible adrenal insufficiency (<18 μg/dL [<497 nmol/L]), but high ACTH levels were only found in one of those three.Cortisol levels decreased significantly after antibiotic treatment, unless steroid therapy was administered. ACTH levels did not correlate with cortisol or proinflammatory cytokine levels.
CONCLUSIONS:Children with meningococcal disease have a wide range of initial plasma cortisol levels, with lower levels found in those who die. Many factors may affect cortisol levels, but adrenal insufficiency is probably uncommon.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>10548217</pmid><doi>10.1097/00003246-199910000-00032</doi><tpages>5</tpages></addata></record> |
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| source | Journals@Ovid Ovid Autoload; MEDLINE |
| subjects | Adolescent Adrenal Insufficiency - blood Adrenal Insufficiency - diagnosis Adrenal Insufficiency - etiology Adrenal Insufficiency - prevention & control Adrenals. Adrenal axis. Renin-angiotensin system (diseases) Adrenocorticotropic Hormone - blood Adrenocorticotropic Hormone - deficiency Bacterial diseases Biological and medical sciences Biomarkers - blood Child Child, Preschool Dexamethasone - therapeutic use Diagnosis, Differential Diagnostic Tests, Routine Endocrinopathies Glucocorticoids - therapeutic use Human bacterial diseases Humans Hydrocortisone - blood Hydrocortisone - deficiency Infant Infectious diseases Medical sciences Meningococcal Infections - blood Meningococcal Infections - complications Miscellaneous Non tumoral diseases. Target tissue resistance. Benign neoplasms Patient Admission Prospective Studies |
| title | Admission cortisol and adrenocorticotrophic hormone levels in children with meningococcal disease: Evidence of adrenal insufficiency? |
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